Effectiveness of Switching from Multiple-Inhaler to Once-Daily Single-Inhaler Triple Therapy in Patients with COPD in a Real-World Setting in Japan
Notice bibliographique
Résumé
Purpose: Following the relatively recent introduction of single-inhaler triple therapies in Japan, this study compared the effectiveness of switching from multiple-inhaler triple therapy (MITT) to once-daily fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) by investigating COPD exacerbations and adherence among patients with chronic obstructive pulmonary disease (COPD) in Japan. Methods: This retrospective, pre–post cohort study using the Medical Data Vision Co. Ltd database identified patients with ≥ 1 inpatient diagnosis and/or ≥ 2 outpatient diagnoses of COPD at age ≥ 40 years prior to the index date (first/earliest date of single-inhaler FF/UMEC/VI initiation from May 1, 2019–February 28, 2022, following a switch from MITT). The proportion of patients with ≥ 1 overall (moderate-to-severe), moderate, or severe COPD exacerbation and rate of exacerbations were assessed at 6 months pre- and post-index. Medication adherence (proportion of days covered [PDC]) was also assessed. Results: In total, 2365 patients were included, with a mean (standard deviation) age of 75.3 (9.7) years, and 77.1% were male. In the 6 months post-switch from MITT to FF/UMEC/VI, there was a statistically significant decrease in the proportion of patients who experienced ≥ 1 overall (11.2% to 8.8%; p =0.0014) and severe exacerbation (4.6% to 3.2%; p =0.0069). There was a similar proportion of patients who experienced ≥ 1 moderate exacerbation pre- and post-switch (6.9% to 6.2%; p =0.2394). Rates of overall (rate ratio [RR]: 0.86, 95% confidence interval [CI]: 0.74– 1.00; p =0.0528) and moderate exacerbations (RR: 0.95, 95% CI: 0.79– 1.13; p =0.5796) were numerically lower post-switch. There was a significant reduction in severe exacerbations post-switch (RR: 0.68, 95% CI: 0.51– 0.90; p =0.0084). Mean PDC was significantly higher in the 6 months post- versus pre-switch (0.83 versus 0.80; p < 0.0001). Conclusion: Patients who switched from MITT to FF/UMEC/VI had reduced exacerbations and improved adherence. These results may help inform healthcare providers on the optimum management strategy for patients with COPD in Japan. Plain Language Summary: Current guidelines recommend that patients with chronic obstructive pulmonary disease (COPD) who experience exacerbations (flare-ups of their symptoms) should be treated with a combination of three treatments, known as triple therapy. Patients can receive multiple-inhaler triple therapy (MITT) or single-inhaler triple therapy (SITT). SITT offers an easier and more convenient treatment plan than MITT and has been shown to improve adherence (the extent to which patients use their treatments as recommended/prescribed). Two SITTs have been approved for use in Japan, including once-daily fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI). Following the relatively recent introduction of SITTs in Japan, this study compared the effectiveness of switching from MITT to FF/UMEC/VI by investigating COPD exacerbations and adherence among patients with COPD in Japan. Patients included in this study were identified from the Medical Data Vision Co. Ltd database, who had switched from using MITT to using FF/UMEC/VI. We assessed COPD exacerbations and adherence to treatment in the 6 months before patients switched from MITT to FF/UMEC/VI and the 6 months following the switch. We found that patients who switched from MITT to FF/UMEC/VI had lower rates of exacerbations in the 6 months after the switch compared with the 6 months before the switch. Patients also had improved treatment adherence in the 6 months post-switch compared with the 6 months pre-switch. The findings of this study may help healthcare providers to prescribe the best treatment plan for patients with COPD in Japan, to help improve their treatment outcomes. Keywords: adherence, chronic obstructive pulmonary disease exacerbations, claims database, fluticasone furoate/umeclidinium/vilanterol, multiple-inhaler triple therapy
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».